Triple Aim Goals  Improved health  Better health care & consumer experience  Lower Costs Tasks  Form a functional board and governance structure  Recruit active participation from regional stakeholders  Define and measure key health challenges for region  Organize and support community - clinician work teams aimed at key health challenges  Assist in securing funding to undertake interventions  Measure and report to community The PHIP will promote the Triple Aim through regional efforts that reflect local needs, assets and capabilities. The expectation is to improve population health through stakeholder collaboration, data-driven prioritization, and regional or local strategies for addressing health disparities that are consistent with the goals of the statewide Prevention Agenda and the State Health Improvement Plan. Mohawk Valley Population Health Improvement Program (PHIP) Status of Health in NYS Needs Improvement  23% of New Yorkers have either diabetes, cardiovascular disease and/or asthma  36% of school children are overweight  Only 20% of New Yorkers meet physical activity recommendations  50 th percentile for preventative care for adults  75 th percentile for colorectal cancer screening Source: Authors’ analysis and adaption from the University of Wisconsin Population health Institute’s county Health rankings model 2010, www. Countyhealthrankings.org/about-project/background 20% Health Care -Access to care -Quality of care 20% Health Care -Access to care -Quality of care 30% Health Behaviors -Tobacco use -Diet & exercise -Alcohol use -Unsafe sex 30% Health Behaviors -Tobacco use -Diet & exercise -Alcohol use -Unsafe sex 40% Socioeconomic Factors - Education - Employment - Income - Family/Social Support 40% Socioeconomic Factors - Education - Employment - Income - Family/Social Support 10% Physical Environment -Environmental quality -Built environment 10% Physical Environment -Environmental quality -Built environment Population Health Social Determinants of Health

PREVENTION AGENDA PRIORITY AREAS: - Prevent chronic diseases -Promote a healthy and safe environment -Promote healthy women, infants, and children - Promote mental health and prevent substance abuse - Prevent HIV, sexually transmitted diseases, vaccine-preventable diseases, and healthcare associated infections Population Health Improvement Program (PHIP) PRIMARY EMPHASIS: - Provides a neutral forum for stakeholders to implement best practices and strategies to promote population health - Utilizes data and analytics to identify and addresses health disparities -Support and advance the Prevention Agenda - Support and advance the State Health Innovation Plan - Serve as resources to DSRIP Performing Provider System STATE HEALTH INNOVATION PLAN PILLARS AND ENABLERS: - Improve Access to care for all New Yorkers - Integrate care to address patient needs seamlessly - Male the cost and quality of care transparent - Pay for healthcare value, not volume - Promote Population Health - Develop workforce strategy - Maximize health information technology - Performance measurement and evaluation MEDICAID DELIVERY SYSTEM REFORM INCENTIVE PATMENT (DSRIP) PROGRAM KEY THEMES: - Integrate delivery - create Performing Provider Systems - Performance-based payments - Statewide performance matters - Regulatory relief and capital funding - Long-term transformation & health system sustainability ALIGNMENT: - IMPROVE POPULATION HEALTH - TRANSFORM HEALTH CARE DELIVERY - ELIMINATE HEALTH DISPARITIES